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Column originally published Aug 28, 2018

Important For Children To Develop Good Bowel Habit

Question: I am frustrated with our five-year-old son. He was toilet-trained more than two years ago, and he was having regular bowel movements mostly every day. Recently, he has become more irregular, and I noticed that his stool is getting larger in size. In the last few weeks, he started having accidents in his pants when he is at home. He said he didn’t know it was coming. Last night, after he had another accident, I sat him at the toilet for an hour; he still couldn’t pass any stool. I wonder whether he is just lazy. What do you think?


I can understand your frustration. Any parent would expect that once a child is toilet-trained, there shouldn’t be any accident at all. Your son has constipation, which was developing slowly over time. Getting frustrated with him doesn’t work; sitting him on the toilet for an hour will only lead to frustration for everyone.

Our stomach and small intestines are responsible for digestion and absorption of nutrients. What cannot be digested is passed into the large intestines. Along the way, water is absorbed for the body to use. Drinking lots of water will reduce the amount of water absorbed through the large intestines; this will keep the stool soft.

Fruits and vegetables can be partially digested. We cannot digest the fibre in them; fibre forms the bulk of our stool. It helps the large intestines to move the stool and to facilitate bowel movement (BM). If we eat too little fruits and vegetables, we can have infrequent BM. When that happens, the stool stays in the large intestines longer, and more water will be absorbed. This makes the stool firmer and larger, and harder to pass.

Therefore, drinking too little water or eating too little fruits and vegetables can lead to constipation. Another factor is holding. If he feels the urge to have BM, and if it is inconvenient at the time (he can be sitting in the car, or in the middle of a game), he may decide to ignore the urge. The urge will go away for a few hours. In the meantime, more water will get absorbed, and the stool will become firmer. When the urge returns, and when he tries to have the BM, he may feel the pain from dry stool, and that can scare him. As a result, he can hold once again. As you can see, the problem will spiral downwards, and his constipation will get worse. When he can’t hold any longer, some may get passed in his pants.

Passing large and hard stool can cause a tear of the anus, also called anal fissure. Some children can develop small hemorrhoids when they try to push for too long.

It is important to make sure your son drinks lots of water. Encourage him to eat more fruits and vegetables. A powder called PEG (polyethylene glycol, often sold as Restoralax) can be very helpful. It can be dissolved in any liquid, with no taste or smell. It holds onto water in the large intestines, therefore, keeping the stool soft. You can talk to your doctor or pharmacist about this. It is important to use PEG daily for weeks to months, until the constipation is well under control.

It is also important to train him to develop a regular bowel habit. The best time is shortly after a large meal, like the supper. This is the time when our intestines are most active, and stool is moved to the rectum, just above the anus. Sit him at the toilet at that time and encourage him to relax and push the stool out. Once he develops a regular bowel habit, it will be less likely for constipation to recur.